How It Works and Who It’s For

The Marketplace is for Oklahoma residents who:

• Live in Oklahoma

• Are lawfully present in the U.S.

• Are not incarcerated

• Are not enrolled in Medicare

It is intended for people who do not have affordable employer coverage, Medicaid, or CHIP. Most enrollees qualify for financial assistance, such as premium tax credits and cost-sharing reductions, based on income and household size. The Marketplace also provides access to SoonerCare (Oklahoma Medicaid) for those who qualify.

Open Enrollment Period in Oklahoma

• Open Enrollment for 2025: November 1, 2024 – December 15, 2024, for coverage starting January 1, 2025. Enrollments after December 15 may result in a coverage gap.

• Outside this period, you need a qualifying life event to enroll or change plans.

Special Enrollment Period (SEP) Rules

You may qualify for a SEP if you experience a qualifying life event, such as:

• Loss of other health coverage (including Medicaid, employer coverage, or SoonerCare)

• Marriage or divorce

• Birth or adoption of a child

• Change in residence

• Gaining U.S. citizenship or legal presence

• Release from incarceration

Most SEPs last 60 days from the event.

Types of Health Insurance Plans Available

Plans are offered in four “metal” tiers:

• Bronze: Lowest premiums, highest out-of-pocket costs; best for those who rarely use care.

• Silver: Moderate premiums and costs; required for cost-sharing reductions.

• Gold: Higher premiums, lower out-of-pocket costs; good for frequent care.

• Platinum: Highest premiums, lowest costs; best for those needing frequent care.

Catastrophic Plans: Available to those under 30 or with a hardship exemption. These plans have low premiums, high deductibles, and cover essential benefits after the deductible is met.

Plan Types:

• HMO: Lower premiums, limited network, referrals required for specialists.

• PPO: Higher premiums, larger network, out-of-network coverage, no referrals.

• EPO: Must use network providers, no out-of-network coverage except emergencies, no referrals needed.

Eligibility for Subsidies and Cost Assistance

• Premium Tax Credits: Available for incomes up to 400% of the federal poverty level (FPL), with expanded eligibility through 2025. Most Oklahoma Marketplace enrollees receive premium subsidies, significantly lowering monthly costs.

• Cost-Sharing Reductions (CSR): For incomes up to 250% FPL on Silver plans, reducing deductibles, copays, and coinsurance.

• Medicaid/CHIP: Oklahoma expanded Medicaid in 2021. Adults under 65 with incomes up to 138% FPL are eligible. CHIP covers children in families with higher incomes.

How to Compare and Choose a Plan in Oklahoma

When comparing plans, consider:

• Premiums: Monthly cost

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Ensure your doctors and hospitals are in-network

• Drug Formularies: Check if your medications are covered

Tips:

• Self-employed: Consider high-deductible plans with HSAs for tax benefits.

• Families: Look for pediatric dental/vision, family out-of-pocket limits.

• Retirees: Marketplace coverage bridges the gap until Medicare at 65.

Top Insurance Providers on the Oklahoma Exchange

For 2025, seven insurers offer Marketplace coverage in Oklahoma:

• Blue Cross Blue Shield of Oklahoma

• Ambetter (Centene/Celtic)

• Medica

• Oscar

• UnitedHealthcare

• CommunityCare HMO

• Taro Health

Plan availability and networks vary by county.

Navigating Oklahoma’s Online Enrollment Portal

How to Apply:

Go to HealthCare.gov and create an account.

Enter household and income information to check eligibility for subsidies or programs.

Compare available plans by premiums, coverage, and network.

Select a plan and complete enrollment.

Pay your first premium to activate coverage.

Where to Get Help:

• Free, in-person help is available from local nonprofit navigators, such as My OK Plan, and certified application counselors statewide.

• Navigators offer confidential, unbiased assistance and can help you compare plans, complete applications, and finalize enrollment.

Alternatives to the Marketplace

• Short-term health plans: Available for up to four months; not ACA-compliant and may exclude pre-existing conditions.

• Off-exchange private plans: Purchased directly from insurers; no subsidies available.

• Faith-based health-sharing ministries: Not insurance, lack ACA protections, but may be an option for some.

Common Mistakes to Avoid During Enrollment

• Not comparing multiple plans before enrolling

• Failing to apply for subsidies or cost-sharing reductions

• Missing the Open Enrollment deadline

• Entering incorrect personal or financial information

• Not updating your income or household information if it changes during the year

• Choosing the wrong metal tier for your needs

• Not checking if your providers are in-network

State-Specific Health Programs or Initiatives

• Medicaid Expansion: Oklahoma expanded Medicaid in 2021, making more adults eligible.

• SoonerCare: Oklahoma’s Medicaid program, now expanded to more adults.

• Insure Oklahoma: A premium assistance program for low-income working adults and small businesses.

• My OK Plan: Free, local nonprofit navigator service to help Oklahomans enroll in Marketplace or SoonerCare coverage.

Oklahoma’s Marketplace offers a wide range of plans, strong consumer protections, and robust assistance for residents seeking affordable health coverage.